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General NPI Number Information
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NPI Number | 1104336072
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Entity Type | Organization
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Legal Business Name | FIRST CLASS ACTIVITY CENTER, LLC
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Dates
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Enumeration Date | 10/05/2017
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Last Update Date | 03/23/2026
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Provider Practice Location Address
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Address Line | 308 E 2ND STREET SUITE A
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City | ALICE
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State | TX
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Zip | 78332-4826
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Country | US
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Telephone | 361-356-4265
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1877
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City | ALICE
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State | TX
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Zip | 78333-1877
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Country | US
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Telephone | 361-356-4265
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | CARL MATHEWS
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Credential |
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Telephone | 361-356-4265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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